I found the perfect JAMA article explaining that sycophancy is programmed into Artificial Intelligence (AI) therapy chatbots.
This reminded me of Marvin the paranoid android (“Life! Don’t talk to me about life!”) in the book series “The Hitchhiker’s Guide to the Galaxy” by Douglas Adams. Marvin is an incredibly depressed robot who would never make a good psychotherapist.
There’s even a Facebook page listing someone posts of questions to ChatGPT about non-inspirational quotes from Marvin.
If programmers can make sycophantic AI therapists, there should be a way to make them less sycophantic. For more specific information, you can check out this relatively recent article published in Psychiatric Times by Dr. Allen Francis, MD and Justin Angel, a tech expert. I would probably substitute the term “confabulation” for “hallucinations” in most places where you read the latter.
I saw an excellent post on Artificial Intelligence (AI) in Dr. George Dawson’s post today, “The Problems With AI Are More Readily Apparent.” He mentions AI producing confabulations which are sometimes called hallucinations in AI. I distinguish hallucinations from confabulations because the former are sensory or perceptual problems while confabulations are making things up. In dementia, confabulations are often described as attempts to fill in gaps in knowledge or memory without any intention to deceive.
I sometimes read that AI is being sycophantic in its interactions with humans, which sounds a little strange to me. The definition of sycophancy is more about trying to please someone else by being obsequiously flattering. It’s puzzling but I have gotten that impression from AI, yet it’s a machine and I don’t know how anyone would program AI to be sycophantic because it’s a human trait.
On the other hand, I got a comically sycophantic reply from AI to my question inquiring about the definition of Calvinball Cribbage. It’s just a made-up term and, to be fair, I’ve also gotten bluntly frank denials from AI that there is any such thing as Calvinball Cribbage.
As a reminder, Calvinball is a term that arose from a comic strip called Calvin and Hobbes. In the strip, the characters invent a game called Calvinball and the only rule is making up the rules as you go along, although there is a goal of capturing your opponent’s flag. But you can’t play it the same way twice.
The most recent hilarious AI confabulation I’ve previously posted about was when Sena and I played our game of 11-card cribbage. There are cribbage players out there who make fun of such variations from standard 6-card cribbage and the name for it from one such player was “Calvinball crib.” My simple question was as usual, “What is Calvinball Cribbage?” The reply is copied below:
“Calvinball Cribbage is a humorous mashup of the chaotic, rule-free game from Calvin & Hobbes with traditional Cribbage, often involving themed boards or rule modifications, where the core idea is applying Calvinball’s fluid, make-it-up-as-you-go spirit to Cribbage’s scoring and play, adding wild, non-sensical rules like using mallets, changing hand values, or scoring points for silly actions, making each round unique and unpredictable, not a single defined game but a creative approach to Cribbage.
What it is (The Calvinball Aspect):
No Fixed Rules: Just like original Calvinball, there’s no single set of rules; the players invent them as they go.
Rule Changes: A key rule is that rules can’t be repeated, and players constantly invent new scoring, actions, or penalties.
Props & Actions: You might use mallets, balls, trees, or make up actions like “scoring three points for pointing at a cloud” or “losing a turn for looking left”.
How it Applies to Cribbage:
Themed Boards: You can find or make custom cribbage boards featuring Calvin & Hobbes, adding visual flair.
Modified Scoring: Instead of just points for pairs and runs, you might add a “Hobbes Bonus” for a specific card or penalize for “too much logic”.
Strategic Chaos: Players still play cribbage (cards, pegs, crib), but the gameplay is constantly disrupted by invented rules, turning strategic plays into potential jokes or absurd victories.
Example Calvinball Cribbage “Rules”:
“If you play a 7, you must hop on one foot until your next turn”.
“The crib gets 5 points if it contains a card with a face on it” (referencing Calvin’s drawings).
“A ‘skunk’ is achieved by making your opponent laugh out loud”.
In essence, Calvinball Cribbage is about injecting unpredictable fun and silliness into the structured world of cribbage, making it a game of spontaneous creativity rather than strict strategy. “
This could be an example of sycophantic confabulation because almost all of it was probably cooked up by AI from scanning my blog posts about the subject. What’s a little eerie about it is that I never published any specific rules or strategies about the fictional game of Calvinball crib. You can actually find and purchase a Calvin and Hobbes cribbage board from a shop in Canada.
While this is an example of the occasional comicality of AI, that shouldn’t lead us to deny that it can do scary things, some of which Dr. Dawson describes. My early experiences a couple of years ago with what used to be called Google Bard were somewhat alarming because it confabulated then. And it still does.
Sena bought some device for neck and shoulder massage called the Shiatsu cordless heat massager today. She tried it and then wanted me to try it. I’m not up for massagers of any kind, especially after seeing the extraterrestrial massage torturer I posted about early this month, “So, Is This Anything?”
She didn’t want it for various reasons. It doesn’t get warm enough, it’s difficult to hold on to it, and has this general weirdness that’s difficult to describe. That’s why I made a little video about it. Sena made me do it.
OK, so the title is a little provocative; on the other hand, this is my take on a legitimate treatment for depression that was just approved by the FDA only last week. A company called Flow Neuroscience is marketing the newly approved FL-100 device for treatment of depression and their website definitely has their marketing skills down. And I definitely was reminded of a TV commercial about removing your own appendix.
That’s my smartass joke, but hang on, there’s more to it than jokes. I had to search around a while to find actual FDA web evidence that they actually did approve the FL-100, but I was saved by the reliable and trustworthy Psychiatric Times article about the FL-100 with references that I could verified the FDA’s approval.
So, I’m a retired psychiatrist and I was a clinician educator type doctor, not a neuroscientist, but I can read the FDA approval document section XV. Conclusions Drawn from Preclinical and Clinical Studies (starts on page 12). It boils down to, yeah, this device’s probable benefits outweigh its probable risks.
The Effectiveness Conclusions subsection on effectiveness outcomes at Week 10 contains what sounds like realistic answers: “The medical literature lacks consensus regarding what constitutes a clinically significant or meaningful between-group difference in HDRS-17 scores. As such, the clinical significance or meaningfulness of the between-group difference of -2.3 points on the HDRS-17 scale has not been established. Nevertheless, the 2.3 point between-group difference helps support the view that FL-100 provides probable benefit.”
I’m not familiar with the EQ-5D-3L scale of health-related quality of life but the summary says:
“The EQ-5D-3L measures a person’s health-related quality of life by assessing five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. There was no between-group statistical difference in EQ5D-3L scores at Week 10. The EQ-5D-3L frequently fails to detect mild depressive symptoms, as individuals with subclinical depression often select “no problems” on the anxiety/depression dimension. The insensitivity of EQ-5D-3L is documented in the literature.”
I happen to think that comparison of medical treatments with psychotherapy is a good idea but: “Data were not provided regarding FL-100 used adjunctively with psychotherapy or with psychotherapy and antidepressants.”
The device has no recommendation for use with patients with treatment-resistant depression:
“Patients who previously had an inadequate clinical response to two or more antidepressants at an adequate dose and duration were excluded from the study, limiting the evidence for use of the FL-100 in a more treatment resistant population.”
The potential risks are first degree skin burns if you’re not careful with the electrodes, headaches, and scalp pain. The benefit is modest but outweighs the risk.
You can use the device at home under the supervision of a clinician—they don’t do house calls so you’d presumably do this by zoom call. You can also get advice through an app on your device, which may or may not be a monotonal AI. You pay $500-800 and there won’t be any answers to questions about insurance coverage until at least next spring. But it’s being used by tens of thousands of people in Europe and beyond.
So go ahead, take your own appendix out (just kidding; put that jack knife away!). Did you know that at least one guy actually did that? A Russian surgeon, Dr. Leonid Rogozov managed it in 1961 while he was stranded in Antarctica.
It’s just my opinion, but the headset could be more stylish.
I’ve been reading about artificial intelligence (AI) in general and its healthcare applications. I tried searching the web in general about it and got the message: “An AI Overview is not available for this search.”
I’m ambivalent about that message. There are a couple of web articles, one of which I read twice in its entirety, “Are we living in a golden age of stupidity?” The other, “AI, Health, and Health Care Today and Tomorrow: The JAMA Summit Report on Artificial Intelligence”was so long and diffuse I got impatient and tried to skip to the bottom line—but the article was a bottomless pit. The conflict-of-interest disclosures section was overwhelmingly massive. Was that part of the reason I felt like I had fallen down the rabbit hole?
I recently signed an addendum to my book contract for my consult psychiatry handbook (published in 2010, for heaven’s sake) which I hope will ultimately protect the work from AI plagiarism. I have no idea whether it can. I delayed signing it for months, probably because I didn’t want to have anything to do with AI at all. I couldn’t discuss the contract addendum with my co-editor Dr. Robert G. Robinson MD about the contract addendum because he died on December 25, 2024.
I found out today the book is old enough to find on the Internet Archive as of a couple of years ago. One notice about it says “Borrow Unavailable” and another notice says “Book available to patrons with print disabilities.”
All I know is that an “archivist” uploaded it. The introduction and first chapter “The consultation process” is available for free on line in pdf format. I didn’t know that until today either.
Way back in 2010 we didn’t use anything you could call AI when we wrote the chapters for the book. I didn’t even dictate my chapters because the only thing available to use would have been a voice dictation software called Dragon Naturally Speaking. It was notorious for transcribing my dictations for clinic notes and inserting so many errors in them that some clinicians added an addendum warning the reader that notes were transcribed using voice dictation software—implying the author was less than fully responsible for the contents. That was because the mistakes often appeared after we signed off on them as finished, which sent them to the patient’s medical record.
Sometimes I think that was the forerunner of the confabulations of modern-day AI, which are often called hallucinations.
Now AI is creating the clinic notes. It cuts down on the pajama time contributing to clinician burnout although it’s not always clear who’s ultimately responsible for quality control. Who’s in charge of regulatory oversight of AI? What are we talking about?
So, about a week ago, I posted a YouTube video about my first ever time installing an OtterBox protective screen on my new iPhone 17 Pro. I installed the case the same day. I also have a holster with belt clip. If I can do it, anyone can. My smartphone situation is pretty much back to normal now and I won’t have to use the fanny pack.
I did something for the first time today, which was to install the iPhone 17 Pro OtterBox Glass screen protector (that’s a mouthful). I remember putting the screen protector on my old iPhone many years ago and it wasn’t anything fancy. There was no device to help you line things up and apply the screen protector. You put it on by hand and prayed that you could eventually scrape out all the bubbles—if you were lucky enough to get it on straight.
The main reason I made a YouTube video about how to install the screen protector was because I couldn’t find a YouTube video about this particular brand. It turns out all the applicator devices are different and installing them is slightly different for each brand.
Sena ordered the case, screen protector, and holster from OtterBox, which is where I got the original case and holster for my old iPhone. I had to replace the case after the battery swelled up and cracked it five years ago. This reminds me of an old Men in Black 3 quote in which a young Agent K holds a very large mobile phone up to his ear (this film is about time travel and the action is in 1969). Agent J says to him “That’s a bigass phone; don’t hold that up to your head!).
Anyway, I decided to make a video of me installing the OtterBox Glass screen protector. I plan to make a YouTube video of installing the case as well—but that’ll be another day.
Since we’ve gotten new smartphones, we’ve been working on getting up to speed on how to use them. More often they seem to be using us.
In fact, Sena is pretty bummed about how much fiddling around with a smartphone you have to do. She used a little flip phone for years and this is a big upgrade (she would say “downgrade”) for her.
Zuckerberg wants to replace smartphones with Artificial Intelligence (AI) glasses. Sena tells me Bill Gates has been talking about replacing them with electronic tattoos.
That reminds me of a 1997 X-Files episode I don’t remember seeing called “Never Again.” Some guy gets a tattoo on his arm of a girl with the words “Never Again” under it. It starts talking to him and making him do crazy things, like buying mobile phones priced around $1,000, which is about what they cost back in 1997. Smartphones cost about the same these days.
Is that how electronic tattoos would work? Or would they just send mind control messages telling you to buy more of the same stocks in Bill Gates’ portfolio?
There are a plethora of new ads and promotional messages that we’ve never seen before:
Buy new armpit removal tool for half-price!
Upgrade to AI-assisted fruitcake recipe idea generating protocol!
Install planet construction and combustion instructions now!
I’m thinking we’ll Never Again purchase new smartphones.
Well, we finally got new phones after several years. I think we bought the old ones from Fred Flintstone. I probably should have got a new phone after the battery swelled up in it so big it was starting to split the case. That was over 5 years ago. I have an iPhone 17 Pro now.
Sena’s always had a flip phone. She got one that still folds up, but it’s a lot nicer. It’s a Galaxy Z Flip7.
I think these phones have a feature that allows you to call extraterrestrials to order pizza. Don’t ask for extra cheese.
I remember we got along OK without portable phones at all for years until a big snowstorm made the streets impassable and I decided I had to sleep in my chair in my office at the hospital. We had only one car. I tried to call Sena to warn her not to drive in the snowstorm, but she’d already left to come pick me up. She got stuck on the way but managed to get unstuck and drove back home. I had no way to get a hold of her while she was out on the road.
We both got flip phones after that. I later got an iPhone triple zero, which ran OK most of the time on diesel. One of the residents talked me into buying one. It was a lesson in evolution. I guess we’re still evolving.
Today’s essay by Dr. Moffic was pretty interesting about the role of video gaming in health for men and women. Computer games were emphasized but it got me thinking about hands-on games that you might thing of as being more old-fashioned—like cribbage.
I wrote a post about cribbage already today, but there’s another angle on it that’s readily adaptable to considering its role in promoting mental health for both men and women.
That reminds me that until yesterday and today, I was on a major losing streak in cribbage with Sena. Cribbage wins and losses seem to occur in streaks and I was beginning to wonder if I’d lost my touch.
There’s a cribbage connection with the electronic gaming realm in that we also play the computer video cribbage game Cribbage Pro. There are three levels, Standard, Challenging, and Brutal (the toughest opponent). We always play Brutal, and often win. There’s a way to play internet cribbage on Cribbage Pro, but we don’t. I prefer playing live. I think the popular view of cribbage is that it’s an old guy’s game. I suspect people think it’s a card game old men play on their lunch hour at the factory.
Nothing could be further from the truth. It’s very popular with women and kids and my guess is that no matter what your gender preference is, there’s a greater diversity of cribbage players out there than anyone realizes.
Playing cribbage promotes and maintains brain health by requiring you to practice basic arithmetic by counting your scores and pegging. You lose a little of that in Cribbage Pro although you can turn on the feature allowing manual counting of scores.
And the American Cribbage Congress (ACC) accommodates internet cribbage tournaments. It’s very popular and competitive. By the way, expanding on my other post today about how to verify your luck in getting a 29 hand in cribbage, you can easily prove it on Cribbage Pro by taking a screen shot of it!
Computer games are fine, but I like to manually shuffle the cards for cribbage. Sena likes to use the shuffling machine—which is very loud but gets the job done. I’ve not yet found a way to “accidentally” lose the shuffling machine (Can’t imagine where it went; must have grown legs and walked downtown!).
We always help each other count our scores. The one time we tried muggins rule, which involves penalizing each other for missing scores by taking them from each other, we just couldn’t seem to get it straight. And it wasn’t as much fun.
There are local cribbage clubs that you could get involved in although they might be hard to find. The nearest one to us is several hours away.
I used to play computer games years ago (although not Nintendo), but nowadays I feel more like Agent K in Men in Black II as he’s trying to quickly learn how to steer a spacecraft using what looks like a PlayStation 2 controller (I used to have one of those).
after K turns on the auto pilot during the chase…
Agent K: It is not automatic pilot.
Agent J: He doesn’t work when we’re in hyperspeed.
Agent K: I could really use a steering wheel!
Agent J: We don’t have no damn steering wheel! This is what we got! [turns off auto pilot] Didn’t your mother ever give you a Gameboy?
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